The Justice Department’s scrutiny of Medicare Advantage risk adjustment is intensifying, with two recent settlements totaling nearly $1.1 billion highlighting federal concerns about diagnosis coding practices that can increase payments to health plans. The latest came Aug. 27, when The…
Medicare Advantage
CMS said its enforcement efforts have resulted in blocking more than $1.6 billion in possibly improper Medicare lab payments throughout President Trump’s administration. An Aug. 28 CMS news release said these enforcement actions included savings of $732 million from 157 providers with…
Federal enforcement around Medicare Advantage risk adjustment and billing has ramped up over the past two years, producing multimillion-dollar settlements with insurers, provider groups, and the vendors that handle their diagnosis coding. The combined value of the settlements comes to…
A federal judge has denied Elevance Health’s request for an emergency recalculation of its 2026 Medicare Advantage star ratings. On Aug. 27, U.S. District Judge Lisa Godbey Wood ruled that Elevance waited too long to file for the emergency recalculation…
The Villages (Fla.) Health, a primary and specialty care provider group, has agreed to pay $541.5 million to resolve allegations that it violated the False Claims Act by submitting improper Medicare Advantage diagnosis codes, according to an Aug. 26 news…
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Detroit-based Henry Ford Health saw Medicare Advantage membership climb 45.8% year over year during the first half of 2026 as its insurance business helped drive revenue growth. Seven things to know: 1. Medicare Advantage membership reached 132,566 as of June…
Aetna will stop paying broker commissions on certain Medicare Advantage plans beginning Sept. 15, the company confirmed to Becker’s. “Aetna routinely reviews and updates our distribution strategy, including the commissionable status of our plan offerings,” an Aetna spokesperson said. “As…
As insurers nationwide prepare to take their latest Medicare products to market this fall, SCAN Group is doubling down on an unconventional growth strategy meant to grab the attention of seniors and healthcare leaders alike. “You can’t solve a problem…
There’s widespread gaps in Medicare knowledge among both current beneficiaries and adults approaching eligibility for the program, even as most enrollees express high confidence in their understanding of the program, according to a new eHealth survey. The findings, released Aug.…
Humana’s New York product is the lowest-ranked Medicare Advantage plan for member satisfaction this year in JD Power’s 12th annual MA study. The consumer insight firm published its rankings of the top MA plans in 12 markets on Aug. 18.…